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. 2024 Sep;144(9):4385-4390.
doi: 10.1007/s00402-024-05538-5. Epub 2024 Sep 11.

A novel radiological index uses the inner canal diameter and the Citak classification index to predict risk factor for aseptic loosening following hinged total knee arthroplasty

Seper Ekhtiari  1 , Tanis Worthy  2 , Luc Rubinger  2 , Ainhoa Alvarez Valdivielso  3 , Laura Puri  4 , Justin de Beer  2   5 , Mustafa Citak  6 , Thomas J Wood  2   5
Affiliations

A novel radiological index uses the inner canal diameter and the Citak classification index to predict risk factor for aseptic loosening following hinged total knee arthroplasty

Seper Ekhtiari et al. Arch Orthop Trauma Surg. 2024 Sep.

Abstract

Introduction: It remains unclear if distal femoral morphology should be a key consideration when selecting the implant or fixation strategy. A novel radiological index has been proposed to classify patients' distal femoral morphology. This study aims to evaluate the validity of this classification system in a cohort of patients undergoing hinged Total Knee Arthroplasty (TKA), and to determine if distal femoral morphology is a risk factor for aseptic loosening or all cause revision following hinged TKA.

Materials and methods: This study was a retrospective analysis of our institutional database. Fifty-nine patients having undergone hinged TKA with adequate radiographs for examination were eligible for inclusion. Radiographic measurements were performed using the Citak radiological index criteria. The proportion of aseptic loosening and all-cause revisions were compared between the different classification groups.

Results: The analysis included 41 females (69.5%) and 18 males (30.5%). The mean age of the participants was 71.2 years (SD = 12.6). For inner canal diameter patients were classified as: Type A (31/59, 53%), Type B (19/59, 32%), and Type C (9/59, 15%). For the Index Classification Group, patients were classified as: Group A (26/59, 44%), Group B (20/59, 34%), and Group C (13/59, 22%). There was no significant difference in overall revision rate between the three groups (χ2 = 3.25, P = .197 from a Chi-square test). There was a significantly higher rate of aseptic loosening in Group C compared to Groups A and B, with no significant difference between Groups A and B in terms of aseptic loosening rates (χ2 = 8.72, P = .013 from a Chi-square test).

Conclusions: Distal femoral morphology plays an important role in the risk of aseptic loosening following hinged knee replacement, and should be considered when deciding implant type and fixation in these patients.

Keywords: Aseptic loosening; Distal femur; Hinged total knee arthroplasty; Novel classification index; Radiological.

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Conflict of interest statement

Declarations Ethical approval This is a retrospective chart review study. This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Hamilton Integrated Research Ethics Board (HiREB) on 10-Nov-2022. Consent to participate Data for this study was obtained from a long-term ongoing prospectively tabulated database with approval from the local ethics board. Patient level consent was not required. Consent for publication The authors confirm that consent was obtained to use the image in Fig. 1. Competing interests Seper Ekhtiari received a travelling fellowship grant from The Hip Society/ME Müller Foundation. Received support to attend Arthrex Munich Hip Preservation Cadaver Course and Stryker Amsterdam Hip Cadaver Course. Ainhoa Alvarez Valdivielso received a Grant for 42nd SICOT Orthopaedic World Congress and a Grant from Medtronic to attend the 37th GEER meeting. Mustafa Citak. Mustafa Citak received Payment or honoraria from Waldemar Link Hamburg for lectures, presentations, speakers bureaus, manuscript writing or educational events and is the Chair of Sicot Research Education and Membership Committee. All other authors have no relevant financial or non-financial interests to disclose.

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